Food Safety Compliance System (FoSCoS)
[Link]
Form A
[See Regulation 2.1.1, Regulation 2.1.7]
Application for Registration under food safety and Standards Act,2006
Application No: 30250811121071371 Application Type: New Registration
Name of Applicant / KAILASH BAKARAM Application Date: 11-08-2025
Company: LUTE C/O MR. Kind of Business: Trade/Retail - Retailer
KAILASH BAKARAM
LUTE / Lute Kirana
and General Stores
Designation: Individual
Address of Premises Where Food Business Is Located
Address: Ms. Lute Kirana State: Maharashtra
and General Store
Sub-Division/Station/ Lakhani
Main Road Lakhan
Division:
District/Region/Zone: Bhandara Pan No: AHEPL2363E
Village: N/A Name: KAILASH BAKARAM
Pin Code: 441804 LUTE
Nearest Landmark: N/A DOB: 24-12-1976
Gender: MALE
Correspondence Address Details
Address: Ward No.5 State: Maharashtra
Murmadi Sub-Division/Station/ Lakhani
District/Region/Zone: Bhandara Division:
Village: N/A Pin Code: 441804
Contact Details
Telephone No: N/A Fax: N/A
Mobile No: 9588447526 Email-ID: kailashlate842@gmail
Contact Person: KAILASH .com
BAKARAM LUTE Aadhaar No: 65XXXXXXXX16
Other Details
In case of New business – intended date of start: 11-08-2025
Source of Water Supply: N/A
Sanction Electricity Load or HP Used: No
Number of years applied for: 1
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Detail(s) of Food Item
[Note:Only standardised food products are allowed to be manufactured as per the list available on FoSCoS.]
Other than Manufacturer Unit
Sl. Name of the food category
No
1 04 - Fruits and vegetables (including mushrooms and fungi, roots and tubers, fresh pulses and
legumes, and aloe vera), seaweeds, and nuts and seeds
2 06 - Cereals and cereal products, derived from cereal grains, from roots and tubers, pulses, legumes
and pith or soft core of palm tree, excluding bakery wares of food category 7.0
3 12 - Salts, spices, soups, sauces, salads and protein products
Document(s) Details
[Link]. Documents Description Uploaded Document
1 Identity Proof - Aadhar Card View
2 Photo View
Other Document(s) Details
[Link]. Documents Description Uploaded Document
1 Rent Agriment view
2 NOC by Municipality/Panchayat view
3 Photographs of the unit (Entrance/Front facing end of the unit) view
[Link]. Mode Of Payment Payment Date Transcation Number Razorpay ID Amount
1 Razorpay 11-08-2025 656939768269389 pay_R3xsafDG1UJXJl 100.00
I/We declare that:
I/We have read,understood and shall abide all provisions of FSS Act,2006 and Rules, Regulations made
therein and orders issued from time to time applicable to declared food business.
I/We assure that articles of food mentioned in form satisfy the requirements of FSS Act 2006, Rules and
Regulations made thereunder.
I/We shall comply with the general hygiene and sanitary requirements as mentioned in the Schedule 4 of
the FSS (Licensing and Registration of Food Businesses) Regulations, 2011.
Expected Annual turnover of the food business is under Rs.12 Lacs. I will apply for License as and when
annual turnover of food businesses exceeds Rs. 12 Lacs.
I have read/understood the punishment provision under Section 61 of FOOD SAFETY AND STANDARDS ACT,
2006."61. Penalty for false information. If a person, in connection with a requirement or direction under this
Act, provides any information or produces any document that the person knows is false or misleading, he
shall be liable to penalty which may extend to ten lakh rupees."
I do hereby solemnly affirm and declare that all information and particulars furnished here by me are true and
correct to the best of my knowledge.
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Declaration || Condition of License || Inspection Checklist
घोषणा || अनुज्ञिप्त की शतेर्ं || िनरीक्षण जांच सूची
Date & Time : 11-08-2025 14:09:39 IST
Applicant Name : KAILASH BAKARAM LUTE C/O MR. KAILASH BAKARAM LUTE / Lute
Kirana and General Stores
Verified through 65XXXXXXXX16
Aadhar :
IP Address : [Link]
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